Propofol
If there’s one drug you need to know inside and out, it’s this one – Propofol. It’s in every OR, every GI lab, and every ICU. It’s elegant, fast, and powerful. But with great power comes great responsibility (and significant hypotension).
Category: Drugs
Xenon: The Noble Anesthetic Agent
Xenon is an anesthetic agent that stands out for its unique properties. This noble gas has gained attention in recent years as an ideal anesthetic with remarkable pharmacological properties.
Pharmacodynamics of Nitrous Oxide
Pharmacodynamics examines how nitrous oxide exerts its effects on the body. Understanding these mechanisms is crucial for anesthesia trainees to appreciate both its therapeutic benefits and potential adverse effects
Nitrous Oxide
Nitrous oxide (N₂O) is frequently encountered in today’s clinical practice. This colorless, non-flammable gas has a fascinating history and remains one of the oldest anesthetic agents still in use today. It was first synthesized by English chemist Joseph Priestley in 1772, though he didn’t recognize its potential medical applications.
TIVA – Total Intravenous Anesthesia
TIVA uses IV agents (propofol + remifentanil) for anesthesia without inhalational gases. Regimens: Propofol (TCI 2–6 mcg/mL or 100–200 mcg/kg/min) + remifentanil (TCI 2–6 ng/mL or 0.05–0.3 mcg/kg/min). Monitoring: BIS (40–60) ensures depth. Ideal for MH risk, PONV-prone patients, or neurosurgery. Enables precise titration and rapid emergence.
Atracurium
Atracurium is an intermediate-acting, non-depolarizing neuromuscular blocker. Hofmann elimination (independent of renal/hepatic function). Causes histamine release (risk of hypotension/tachycardia). Dose: 0.4-0.5 mg/kg IV. Reversed by neostigmine/glycopyrrolate. Ideal for patients with organ dysfunction.
Isoflurane
Isoflurane is a potent, reliable inhalational anesthetic (MAC ~1.2%) with moderate blood solubility (λB:G 1.4). Known for cardiovascular stability and bronchodilation, it uses a standard vaporizer. Pungent but less than Desflurane; suitable for pediatric maintenance. Cost-effective with minimal metabolism, making it a staple in anesthesia practice.
Desflurane
Desflurane is a potent inhalational anesthetic prized for its rapid emergence due to low blood solubility (MAC 6-7%). Ideal for outpatient surgery and fast wake-up needs. Requires a special heated vaporizer. Pungent and irritating, it’s contraindicated for inhalational induction. Minimal metabolism offers low toxicity risk. Key for anesthesia efficiency.
Sevoflurane
Sevoflurane is a potent, non-pungent inhalational anesthetic (MAC ~2%) with low blood solubility (λB:G 0.65). Ideal for smooth inhalational induction (especially pediatrics) and rapid emergence. Uses a standard vaporizer. Minimal airway irritation; monitor for Compound A with low-flow anesthesia. Low metabolism ensures safety.
Midazolam
Midazolam is a short-acting benzodiazepine used for preoperative sedation, anxiolysis, and amnesia. Rapid IV onset (1-2 min), metabolized hepatically. Causes respiratory depression; requires reversal with flumazenil. Synergistic with opioids. Key for procedural sedation and anxiolysis in anesthesia.
Xenon: The Noble Anesthetic Agent
Xenon is an anesthetic agent that stands out for its unique properties. This noble gas has gained attention in recent years as an ideal anesthetic with remarkable pharmacological properties.
Pharmacodynamics of Nitrous Oxide
Pharmacodynamics examines how nitrous oxide exerts its effects on the body. Understanding these mechanisms is crucial for anesthesia trainees to appreciate both its therapeutic benefits and potential adverse effects
Nitrous Oxide
Nitrous oxide (N₂O) is frequently encountered in today’s clinical practice. This colorless, non-flammable gas has a fascinating history and remains one of the oldest anesthetic agents still in use today. It was first synthesized by English chemist Joseph Priestley in 1772, though he didn’t recognize its potential medical applications.
TIVA – Total Intravenous Anesthesia
TIVA uses IV agents (propofol + remifentanil) for anesthesia without inhalational gases. Regimens: Propofol (TCI 2–6 mcg/mL or 100–200 mcg/kg/min) + remifentanil (TCI 2–6 ng/mL or 0.05–0.3 mcg/kg/min). Monitoring: BIS (40–60) ensures depth. Ideal for MH risk, PONV-prone patients, or neurosurgery. Enables precise titration and rapid emergence.
Atracurium
Atracurium is an intermediate-acting, non-depolarizing neuromuscular blocker. Hofmann elimination (independent of renal/hepatic function). Causes histamine release (risk of hypotension/tachycardia). Dose: 0.4-0.5 mg/kg IV. Reversed by neostigmine/glycopyrrolate. Ideal for patients with organ dysfunction.
Isoflurane
Isoflurane is a potent, reliable inhalational anesthetic (MAC ~1.2%) with moderate blood solubility (λB:G 1.4). Known for cardiovascular stability and bronchodilation, it uses a standard vaporizer. Pungent but less than Desflurane; suitable for pediatric maintenance. Cost-effective with minimal metabolism, making it a staple in anesthesia practice.
Desflurane
Desflurane is a potent inhalational anesthetic prized for its rapid emergence due to low blood solubility (MAC 6-7%). Ideal for outpatient surgery and fast wake-up needs. Requires a special heated vaporizer. Pungent and irritating, it’s contraindicated for inhalational induction. Minimal metabolism offers low toxicity risk. Key for anesthesia efficiency.
Sevoflurane
Sevoflurane is a potent, non-pungent inhalational anesthetic (MAC ~2%) with low blood solubility (λB:G 0.65). Ideal for smooth inhalational induction (especially pediatrics) and rapid emergence. Uses a standard vaporizer. Minimal airway irritation; monitor for Compound A with low-flow anesthesia. Low metabolism ensures safety.
Midazolam
Midazolam is a short-acting benzodiazepine used for preoperative sedation, anxiolysis, and amnesia. Rapid IV onset (1-2 min), metabolized hepatically. Causes respiratory depression; requires reversal with flumazenil. Synergistic with opioids. Key for procedural sedation and anxiolysis in anesthesia.